Back in 2014, I was sitting on a beach with my wife while on a family holiday to Lewis. 'This would be a great place for the kids to grow up,’ I said. My wife replied, ‘So why don’t we move?’ At the time, I was leading COSLA’s work on health and social care integration and my wife was working as a clinical psychologist for NHS Lanarkshire - but we decided to take on the adventure. I applied for the Chief Officer post and my wife applied for a consultant psychologist position and the rest, as they say, is history.
We’ve been here for four years now. The experience has surpassed our expectations, having achieved a quality of life dividend - good schools, well developed local infrastructure, access to the outdoors and new cultural experiences.
We’ve both had rewarding professional experiences. The delivery of health and social care in a remote and rural environment presents many challenges, many of which are less pronounced on the mainland. For instance, we carry higher numbers of vacant posts given the gravitational pull of the urban centres, which can make it difficult from a service resilience perspective. We have a small population but a massive geography - from north to south, the island chain covers the same distance as Glasgow to Aberdeen. Professionals often have to be expert generalists or cover different specialisms - for example, my wife provides the psychology input for both CAMHS and older adults.
But these very challenges stimulate innovation. For example, thanks to our excellent NHS digital team, remote monitoring and diagnosis is an increasingly prominent part of our local service structures. Our general practices are responsive and holistic in the care provided. And our wider public services are increasingly planned across agencies - for example, a new campus is being planned for Barra which will deliver a fully integrated community facility.
And of course I’d like to think that Western Isles Health and Social Care Partnership is contributing to the improvement of health and social care in the islands: we’ve closed a long-stay dementia ward in favour of community based support; we’ve redesigned homecare to give our teams predictable hours and more flexibility to respond to need; we’ve built a new intermediate care team; we’re working with other public agencies like Scottish Fire and Rescue to prevent the escalation of need and tackle lower levels of vulnerability – the list goes on. And we’re beginning to see positive results in terms of patient and service user experience.
There’s more to do of course – there always is – but we have a strong sense of where we want to get to and how we’re going to get there. I see the reform of primary care as the next big opportunity. There has been significant discussion within rural Scotland in particular about the new GP contract and its implementation – it’s fair to say there have been some sceptical voices but I have to say I feel positive about it. If we get it right, it promises to improve not just primary care but the wider community healthcare system. We’ve been working very collaboratively with our local practices, ensuring that we build capacity to deliver holistic care and support for the people we serve.
So we are feeling positive about our future. Indeed, the Care Inspectorate and HIS recently reported on the significant levels of improvement within the partnership. But don’t take my word for it. Come and see us. Join us.
Ronald Culley is Chief Officer Western Isles Health and Social Care Partnership